“A deep wound under my heart”: Constructions of complex trauma and implications for women’s wellbeing and safety from violence

Women with experiences of complex trauma are a significant but overlooked group of victims and survivors of genderbased violence in Australia. Complex trauma refers to multiple, repeated forms of interpersonal victimisation and the resulting traumatic health problems and psychosocial challenges. In Australia, one quarter of women subject to gendered violence report at least three different forms of interpersonal victimisation in their lifetime, such as child sexual abuse, domestic violence, sexual assault and stalking (Rees et al., 2011). This group has a high level of healthcare utilisation linked to mental illness, suicidality and substance abuse. They are in frequent contact with crisis services and police due to domestic violence and sexual assault, with some women reporting extreme forms of gender-based violence that fall outside existing policy frameworks (Middleton, 2013; Salter, 2017). The health and safety needs of women with experiences of complex trauma are interlinked, since poor health and unmet need can increase their risk of victimisation, while ongoing victimisation compounds trauma-related mental illness (Salter, 2017). The relationship between complex trauma, mental illness and violence unfolds in diverse ways according to women’s social position, lived experience and geographical location. Experiences of complex trauma are not well recognised across mental health practice or related fields, leading to inconsistent, inappropriate and sometimes re-victimising treatment. Complex trauma is a contested area in which the medical model of mental illness, and the widespread stigmatisation of distressed women as “hysterical”, malingering or simply “mad” (Ussher, 2011), is in conflict with trauma-informed paradigms of support and treatment (Herman, 1992). This conflict is evident in the unpredictable responses faced by women with experiences of complex trauma in a range of settings. At the policy level, complex trauma overlaps with frameworks on violence against women and mental health. However, the impact of complex trauma is not comprehensively addressed by these frameworks, and this contributes to the fragmented response to women in distress. Responses to women who have experienced complex trauma need to be sensitive, coordinated and consistent between services and agencies to ensure women’s wellbeing and safety from violence. However, the development of shared frameworks of practice for addressing complex trauma has been forestalled by a lack of professional consensus and understanding. There is a need for holistic research into “best practice” responses to address complex trauma that place the needs and understandings of diverse women at the centre. This project sought to develop a comprehensive picture of how complex trauma is being constructed in public policy and practice by women with experiences of complex trauma.